NHS Improvement Agency Usage Board Diagnostic Tool

Transcription

1 NHS Improvement Agency Usage Board Diagnostic Tool Adam Thwaites Senior Manager, Workforce Efficiency 20 April 2016

2 Today I will cover Context Agency rules Workforce improvement Diagnostic tool 2

3 Context Use of agency staff has risen from 1.8 billion to 3.3 billion in 3 years, leading to concerns about: Quality of services Financial sustainability Causes Demand for services and heightened emphasis on quality and safety Movement towards 7 day services Workforce supply issues 3

4 Regulation: agency rules Agency Rules Requirements Comply with a ceiling for trust expenditure Continue to procure all agency staff at or below the price caps Use approved framework agreements to procure all staff Agency Rules Aims Significantly reduce agency spend Improve transparency on agency spend Bring greater assurance on quality of agency supply Encourage staff to return to permanent and bank working 4

5 Regulation: agency rules implementation 01/09/2015 Trusts sent annual ceilings for agency nursing staff 01/02/2016 Agency price caps reduced 01/04/2016 Trusts required to procure agency staff via approved framework agreements 15/10/2015 Price cap consultation launched 23/11/2015 Price caps and reporting implemented 01/04/2016 Further reduction in price caps 19/10/2015 Nursing framework rule takes effect 13/11/2015 Price cap consultation closes 01/04/2016 Annual ceilings to apply to all staff An annual ceiling for total nursing agency spend was launched in September 2015 Trusts were sent their annual ceilings based on 2014/15 nursing agency spend rates Trusts submit monthly profile of planned nurse agency spend to reach ceiling 5 Price caps are useful tools on the rate paid to agency workers/hour Important to set price caps low enough to: Generate savings But, not so low as to discourage staff from working agency shifts where needed There may some circumstances where the rules might be suspended or flexed Reference is provided on last slide

6 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar Monthly total agency expenditure ( m) Total agency spend has been falling since autumn Ratchet 2 Ratchet Actual New trajectory ( 2.5bn in 2016/17) 6

7 NHS Improvement s approach to agency is based on two approaches Agency rules Delivered through the regulatory teams formerly in TDA / Monitor Regional teams Eyes and ears of the organisation manage relationships and delivery with trusts Regulatory Provider sustainability Supporting short-term operational improvements, longer term sustainability solutions and leadership development NHS Improvement Nursing directorate Lead on workforce policy and improvement issues Improvement 7

8 The agency diagnostic tool This tool focuses on five areas/domains involved in use of agency staff to help you diagnose issues, decide ways forward and implement improvements quickly. You can use it alongside other NHS Improvement resources and more direct support. 2.Technology 3.Controls and information 1.Leadership 4.Staff engagement, recruitment and bank 5. Procurement We welcome any queries and suggestions for improvement. Please contact: 8

9 The five domains Recruitment through social media Refreshed agency authorisation process E-rostering upgrade Technology Controls and information Agency usage tracker Clinician-led change workstreams Leadership Single executive lead Regional collaboration Staff Engagement, Recruitment And Bank Procurement Regular supplier management meetings Additional resources for the bank team Managed service for doctors 9

10 The domains Domain 1: Leadership 1 Is there clear senior clinical ownership of the agency issue at the Trust? 2 Does the Trust have a credible strategy for reducing agency staff? 3 Has the Trust Board engendered a collaborative culture across the organisation? 4 Do the Trust s senior managers have the skills, capacity and capability to lead the agency initiative? 5 Is the Trust working to tackle external factors of agency usage? 6 Does the Trust have a corporate policy and procedure on agency workers? 7 Is the Board sufficiently aware of potential risks? 10 Domain 2: Technology 1 Is there a Board Director actively leading and responsible for delivery of benefits from the automation programme? 2 Has the Trust effectively embedded an end-to-end booking and roster process supported by electronic systems? 3 Has the process for booking vacant shifts been devolved, where possible, down to staff delivering the service? 4 The automated systems are managed at delivery level with a senior manager responsible for oversight Domain 3: Controls and Information 1 Is there a Board Director actively overseeing agency spend? 2 Is temporary staffing effectively managed at delivery level by clinical staff 3 Have governance arrangements e.g. signoff/authorisation procedures and policies been updated? 4 Is temporary and permanent staff rota information all available in one place, regularly reviewed and updated? 5 Has the Trust compared performance on agency usage with peers? (Within the Trust and externally) 6 Have targets/kpis been introduced? 7 Does the Trust control it s own substantive staff working through a commercial agency at it s sites 8 Is the basic workforce and management information robust to enable effective control? 9 Are the Trusts billing processes robust? 10 Has the Trust assessed the level of utilisation of the permanent staff for additional duties 11 Does the Trust actively seek patient satisfaction, staff feedback and quality of care information to identify temporary staffing problems on wards/departments 12 Have the processes for permanent staff recruitment and retention been assessed? 13 Is robust management information available to enable real-time decision making? 14 Does the Trust plan/model/forecast workforce demand in the near and longer term?

11 The domains Domain 4: Staff Engagement Recruitment & Bank 1 Have staff been engaged to identify the causes for agency usage by area? 2 Are the substantive staff effectively engaged to cover gaps in rotas? 3 Has there been a broad communications initiative to raise awareness of the agency challenge? 4 Have trade union representatives been effectively engaged to resolve agency issues? 5 Have other flexible staffing options been considered? 6 Does the Trust actively promote the benefits of bank working? 7 Have skill-mix considerations to meet demand been considered? 8 Has there been a broad communications initiative to recruit and involve former staff? 9 Has there been wide-ranging engagement to increase the substantive workforce capacity? 10 Does the Trust have corporate policies relating to preemployment checks, inductions and performance. management of bank workforce? 11 Has the Trust Bank the capacity and capability to manage the Trust s workforce demands 12 Has the Trust evaluated the commercial impact/cost bank versus overtime and agency work? Domain 5: Procurement 1 Has the Trust reviewed the role of the procurement team? 2 Review transparency of agency rates/unit cost data 3 Are suppliers actively managed? 4 Does the Trust actively manage the agency staff supplier base? 5 Identify how many agency workers are sourced through a frameworks 6 Has the Trust reviewed their preferred supplier list within the last year? 11

12 Using the tool This tool consists of 43 questions that came out of our pilot alongside good practice examples identified from the wider NHS. You can use the questions to diagnose your progress in reducing dependence on agency staff and work out what to do next. It may be useful to re-consider questions you have already asked, as well as those you have not. The red, amber, green or RAG rating (see below) can be used to indicate areas where the trust: needs to carry out new work needs to carry out improvements on work already in place is doing well but this needs to be sustained RAG rating Red: Action required; a need to set-up or carry out new/substantial change Amber: Action required; a need for review and/or improvement Green:. No action required at this time, but will be kept under review Example indicator The answer to the question is unknown or there is little to no evidence of good practice activity/activities Progress has been made or is being made and there is evidence of significant good practice activity/activities, but more work is required. The timescale for this is included There is a broad level of confidence that most good practice activity/activities are in place and embedded as part of business as usual 12

13 Action Planning Domain Action Lead Timescale 1.Leadership 2.Technology 3.Controls & information 4.Staff engagement 5.Procurement 13

14 Activities Timeframe Phases Steps in using the tool 1. Preparation and set-up 2. Diagnosis and action planning 3. Implement and embed 4. Ongoing monitoring/business as usual Week 1 Weeks 2 to 10 Weeks 11 to 18 Week 19 onwards 14 Identification of the senior responsible officer/governance for the programme to reduce the cost of agency staff Identification of key internal stakeholders to take part in the programme Agreement on approach/method for deploying diagnostic tool (including staff engagement) Deployment of agency diagnostic tool (including review of all results) Identification and agreement of high-impact areas for development or improvement Development of high-impact action plan in response to target areas Delivery plan: scope, objectives and expected benefits/key performance indicators (KPIs) Workstream delivery plan: breakdown of action plan into workstream packages and assignment to workstream leads Embedding delivery within trusts existing change/ transformation structure Ongoing monitoring of progress against agreed KPIs (including quality/patient care metrics) Continued review of further work required

15 Good practice involves Examples of good practice include: Executive-level ownership of programme Grip and good governance; operational managers, clinicians, HR and finance teams working together to manage workforce challenges Detailed, accurate management information for workforce planning & day to day decision making Greater control of rostering & staff bank using technology Strong procurement of agency contracts A large, flexible staff bank, available when required Greater consistency in staffing and patient care 15

16 Related resources Rules for all agency staff working in the NHS: Strategy development toolkit: Providing agency support webinar: The DH procurement toolkit is stored on the DH procurement portal. Your procurement team will be able to organise access to the resources available on this site 16

17 The Workforce Efficiency Team can be contacted at